| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1220 |
Whlchr special size/constrc |
186 |
160 |
$1.41M |
| K0108 |
W/c component-accessory nos |
877 |
629 |
$1.02M |
| E1399 |
Durable medical equipment mi |
289 |
164 |
$561K |
| E1390 |
Oxygen concentrator |
8,511 |
7,853 |
$397K |
| K0005 |
Ultralightweight wheelchair |
170 |
154 |
$277K |
| E0601 |
Cont airway pressure device |
3,604 |
3,262 |
$103K |
| K0823 |
Pwc gp 2 std cap chair |
787 |
713 |
$71K |
| E0261 |
Hosp bed semi-electr w/o mat |
2,242 |
2,078 |
$70K |
| E0973 |
W/ch access det adj armrest |
755 |
540 |
$60K |
| E0431 |
Portable gaseous 02 |
3,672 |
3,315 |
$42K |
| E0971 |
Wheelchair anti-tipping devi |
3,934 |
1,979 |
$38K |
| E1028 |
W/c manual swingaway |
777 |
327 |
$31K |
| E2620 |
Wc planar back cush wd <22in |
85 |
75 |
$31K |
| E0570 |
Nebulizer with compression |
2,199 |
2,020 |
$28K |
| K0040 |
Adjustable angle footplate |
308 |
233 |
$26K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,191 |
1,046 |
$25K |
| E2607 |
Skin pro/pos wc cus wd <22in |
145 |
112 |
$25K |
| E1161 |
Manual adult wc w tiltinspac |
26 |
26 |
$23K |
| E0630 |
Patient lift hydraulic |
718 |
654 |
$21K |
| K0001 |
Standard wheelchair |
2,060 |
1,889 |
$19K |
| E0955 |
Cushioned headrest |
250 |
210 |
$15K |
| E0260 |
Hosp bed semi-electr w/ matt |
579 |
519 |
$12K |
| E0961 |
Wheelchair brake extension |
341 |
256 |
$11K |
| K0004 |
High strength ltwt whlchr |
489 |
407 |
$9K |
| E0466 |
Home vent non-invasive inter |
28 |
25 |
$8K |
| K0739 |
Repair/svc dme non-oxygen eq |
77 |
56 |
$7K |
| E1392 |
Portable oxygen concentrator |
733 |
653 |
$7K |
| E2611 |
Gen use back cush wdth <22in |
34 |
34 |
$7K |
| A7030 |
Cpap full face mask |
141 |
126 |
$7K |
| E0951 |
Loop heel |
276 |
209 |
$5K |
| E0978 |
W/c acc,saf belt pelv strap |
234 |
158 |
$5K |
| E2211 |
Pneumatic propulsion tire |
125 |
61 |
$4K |
| A7037 |
Pos airway pressure tubing |
463 |
397 |
$4K |
| E0562 |
Humidifier heated used w pap |
192 |
188 |
$4K |
| A7035 |
Pos airway press headgear |
399 |
344 |
$3K |
| K0816 |
Pwc gp 1 std cap chair |
65 |
64 |
$3K |
| E0990 |
Wheelchair elevating leg res |
34 |
13 |
$2K |
| E2213 |
Pneumatic prop tire insert |
37 |
30 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
77 |
58 |
$1K |
| A7038 |
Pos airway pressure filter |
343 |
256 |
$975.19 |
| E0470 |
Rad w/o backup non-inv intfc |
13 |
12 |
$577.08 |
| E0163 |
Commode chair with fixed arm |
16 |
13 |
$239.30 |
| K0195 |
Elevating whlchair leg rests |
62 |
54 |
$173.82 |
| A7046 |
Repl water chamber, pap dev |
27 |
25 |
$155.89 |
| A7003 |
Nebulizer administration set |
83 |
77 |
$88.78 |
| A7039 |
Filter, non disposable w pap |
13 |
12 |
$51.12 |
| E0156 |
Walker seat attachment |
22 |
12 |
$41.39 |